Resp Flashcards by juliette auffray-baude

Roles of respiratory system

warm, humidify air
Oxygenation
removal of CO2
pH regulation

How well did you know this?

Not at all

Perfectly

dysfunctional breathing def

breathing disorder where breathign pattern is changes, causing dyspnoea and other symptoms AND that cant be explained by resp and cardiac disease.

How well did you know this?

Not at all

Perfectly

hyperventilation syndrome

breathing in excess of metabolic demands, leads to hypocapnia = respiratory alkalosis

How well did you know this?

Not at all

Perfectly

Normal breathing

nose, slow, low
1:2 insp:exp
passive exp
diaphragm

How well did you know this?

Not at all

Perfectly

BPD fight or flight cycle

Perceived threat triggers SNS.
SNS prepares for action so increases depth/rate of breathing (hyperventilation).
hyperventilation = hypocapnia symptoms
hypocapnia symptoms = anxiety
anxiety stimulates SNS = more symptoms
symptoms = more hyperventilation = more anxiety

How well did you know this?

Not at all

Perfectly

Hypocapnia 4 physiological effects

decreased CO2= increased pH = alkalosis
Haldane effect: alkalosis increases O2 afiinity of Hb = decreased O2 provision to cells
electrolyte shift = smooth muscle constriction (lungs)
vasoconstriction = decreased BF

How well did you know this?

Not at all

Perfectly

Hypocapnia signs and symptoms - neuro

confusion, headaches, tinnitus, fait, decreased balance, dizziness, blurry vision, brain fog, epilespy..

How well did you know this?

Not at all

Perfectly

Hypocapnia signs and symptoms - resp

SOB, sighing/yawning, tight chest, cough

How well did you know this?

Not at all

Perfectly

Hypocapnia signs and symptoms - CV

HR increase, palpitation, arrhythmias, cold extremities, angina symptoms, ECG changes

How well did you know this?

Not at all

Perfectly

Hypocapnia signs and symptoms - MSK

twitch, shiver, weakness, tetany, pain, hyperreflexio, increased muscle tension

How well did you know this?

Not at all

Perfectly

Hypocapnia signs and symptoms - psych

anxiety, anger

How well did you know this?

Not at all

Perfectly

Hypocapnia signs and symptoms - gut

cramps, bloating nausea

How well did you know this?

Not at all

Perfectly

Hypocapnia signs and symptoms - other

poor sleep, decreased exercise tolerance, dry mouth, bladder hyperactivity

How well did you know this?

Not at all

Perfectly

Subj assessment of BPD

medical Hx: asthma, allergies, anxiety/panic attack, sinusitis, cough, resp infection. MSK problems, anaemia, CV problems, meds.
social: support, family, home envrmt, lifestyle (diet, exercise), occupation (demands, type support, finance)
tests/investigations: blood test, lung function/spirometry, previous Rx

How well did you know this?

Not at all

Perfectly

Obj assessment of BPD

posture
chest shape
breathing patten
accessory muscle palpation
nose/mouth breathing
nasal patency
hands - cold/clammy
speech
yawning/sighing/
cough
PEFR/max inspP/tidal spirometry

How well did you know this?

Not at all

Perfectly

Nijmegen questionnaire (nymiguen)

score 0-4 for each symptom (never - very often).
>23 = +ve.
symptoms:
chest pain, tense, feeling, SOB, confusion …..

How well did you know this?

Not at all

Perfectly

BPD Treatment (3)

education: normal pattern, abnormal pattern, how it causes symptoms, potential triggers.
awareness of own pattern
retraining:
- start in comfy position, progress to sitting, w motion
- relaxation technique
- nose low slow, aim to activate diaphragm, 1:2 ratio, aim to hold post exp
- use biofeedback (own/pt hands, sandbag)
- can train diaphragm if weak
- refer if see other components(psychological)

Asthma - definition and main symptoms

chronic inflammatory disease of airways from hyper-reactivity to allergen.
wheezing, SOB, tight chest, coughing

Asthma - diagnosis

based on Rx response, signs&symptoms response, absence of alternate explanation

need to take careful clinical Hx and assess spirometry response after bronchodilator/ICS use
no reliable gold standard diagnosis.

Asthma risk factors

enrvrmt
occupation
family hx
other medical conditions
ethnicity - pacific ppl
sex

Asthma triggers

house dust mites
cigarette/wood smoke
animals
weather change
pollen
chemicals - perfume
animals

Aims of asthma Rx

control signs and symptoms, how they affect daily life.
prevent attacks/flare ups.
keep lungs healthy as long as possible.

Asthma management strategies (5) and barriers

management plan -review yearly
smoking cessation - whole household
education - incl ppl surroundings
review inhaler/spacer
regular PEFR readings

barriers: cultural beliefs, family dynamic, cost, age

Asthma meds

reliever therapy (adults)
- long term Inhaled corticosteroid (ICS)/fast B agonist reliever (NOT SABA ALONE).
preventive therapy (adults)
- ICS

AIR therapy - anti-inflam reliever

Inhaler devices for Asthma - considerations, instructions

hand weakness, coordination issues, breath holding ability, adherence. - hold inhaler up right and shake - place inhaler in to spacer opening - seal mouth tightly around mouth piece - press inhaler once - 6 slow breaths, maintaining spacer - remove space and repeat for more doses

Asthma - Physio management (3)

1. breathing retraining for dyspnoea/hyperventilation 2. education on mamagement plan, inhaler/space use and benefit. 3 improvement of CV fitness - increases lung function - decreases airway inflam. - increases QoL - via walking, swimming, biking, gymnastic..

Managing an asthma attack

1. sit person upright 2. give them 4 doses with spacer(4 slow breaths) 3. wait 4 mins 4. no improvements = repeat 4 doses 5. no improvements = AMBO

Asthma warning signs

usual symptoms worsen decreased PEFR, increased dyspnoea, tight chest, wheeze can develop fast and be life threatning

Obstructive Sleep Apnoea (OSA) - definition + pathophysiology

recurrent partial.complete obstruction of upper airways. it is the most common sleep disorder. upper airway collapse, decreased muscle tone, increased intra-thoracic P, changes in neural reflexes.

OSA diagnosis (AHI)

any of: - complete airflow obstruction> 10 secs - airflow reduction for 50% for 10 secs - airflow reduction 30% for 10 secs + O2 desaturation 3% AHI: Apnea-hypopnea index = number of events/total sleep time.

OSA risk factors

large neck circumference - obesity genetics - narrow airway, neuromsk disease, cranio-facial morphology low PA posture - protraction old men

OSA untreated effects

- hypertension risk - increased mortality - stroke, CVD in sever OSA - uncertain increased CV risk in moderate OSA

OSA associated conditions

atrial fibrillation HTN stroke CVD obesity T2DM

OSA symptoms - daytime

- increased somnolence - morning headache - wakign unrefreshed - poor concentration - irritability - impaire memory

OSA symptoms - nighttime

- rapid sleep onset - snoring - witnessed apnoea - choking - nocturia

OSA sleep questionaires (4)

1. Epsworth sleep scale (ESS) - symptom frequency 2. STOP -BANG - risk factor scale 3. Functional outcome of sleep (FOSQ) - functional implications of OSA 4. Pittsburg sleep quality index (PSQI) - functional

OSA management

- CPAP - sleep posture - surgery (UPPP) - dentaal appliances

CPAP

for OSA keeps Positive pressure in ins + exp splints airways open poor adherence, weight gain, no increased PA

benefits PA in OSA

- helps weight loss - decreased apnea severity - strengthens oropharyngeal muscles - mitigates risk factors - decreased fatigue - increased QoL upper airway strengthening - oropharyngeal exercises - wind instruments - singing

Phsyio role in management of OSA

- education and awareness - exercise prescription - motivational interviewing - behavioural change techniques